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Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series.

Cho HS, Seo SH, Park SH, Park JH, Shin DS, Park IH - BMC Musculoskelet Disord (2012)

Bottom Line: Recent concern focuses on the effectiveness of closed methods.The mean time to healing was 6.6 months (range, 3-12 months).Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Background: Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts.

Methods: Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1  years (range, 3-19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15-36 months).

Results: Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3-12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up.

Conclusions: A minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts.

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Serial diagrams of final result of 25 cysts.
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Figure 2: Serial diagrams of final result of 25 cysts.

Mentions: The permanent pathology report confirmed all cysts as UBC. At 4–6 weeks postoperatively, all patients were pain free and had full range of motion of the adjacent joint. Full activity including weight-bearing was resumed within this time in all patients. At the last follow-up, all patients were asymptomatic. Radiographical cyst healing in terms of cortical remodeling was seen at a mean of 6.6 month follow-up (range, 3–12 months) (Figure 1). Fleiss’ kappa value on rating of the modified Neer classication was 0.763. Two patients required a second intervention because of cyst recurrence. The mean interval from initial intervention to a second was 9.0 months (range, 4–14 months). Both recurrences were active cysts located in the proximal humerus and proximal femur. Both patients had a radiographical healing of cyst after mean of 10 additional months of follow-up. Four of the 25 patients had incomplete healing radiographically showing small, persistent radiolucent areas within the original cyst but had enough cortical thickness to prevent fracture. None of four patients needed second intervention until the last follow-up (Figure 2).


Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series.

Cho HS, Seo SH, Park SH, Park JH, Shin DS, Park IH - BMC Musculoskelet Disord (2012)

Serial diagrams of final result of 25 cysts.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475132&req=5

Figure 2: Serial diagrams of final result of 25 cysts.
Mentions: The permanent pathology report confirmed all cysts as UBC. At 4–6 weeks postoperatively, all patients were pain free and had full range of motion of the adjacent joint. Full activity including weight-bearing was resumed within this time in all patients. At the last follow-up, all patients were asymptomatic. Radiographical cyst healing in terms of cortical remodeling was seen at a mean of 6.6 month follow-up (range, 3–12 months) (Figure 1). Fleiss’ kappa value on rating of the modified Neer classication was 0.763. Two patients required a second intervention because of cyst recurrence. The mean interval from initial intervention to a second was 9.0 months (range, 4–14 months). Both recurrences were active cysts located in the proximal humerus and proximal femur. Both patients had a radiographical healing of cyst after mean of 10 additional months of follow-up. Four of the 25 patients had incomplete healing radiographically showing small, persistent radiolucent areas within the original cyst but had enough cortical thickness to prevent fracture. None of four patients needed second intervention until the last follow-up (Figure 2).

Bottom Line: Recent concern focuses on the effectiveness of closed methods.The mean time to healing was 6.6 months (range, 3-12 months).Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Orthopaedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

Background: Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts.

Methods: Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1  years (range, 3-19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15-36 months).

Results: Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3-12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up.

Conclusions: A minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts.

Show MeSH
Related in: MedlinePlus